Uncontrolled diabetes is associated with increased risk of infections. An uncommon but rather serious infection is pyomyositis which is a purulent infection of the skeletal muscle. Delay in recognition and diagnosis can lead to serious complications. We report the case of a 44‐year‐old male patient with a background of uncontrolled diabetes who presented with bilateral thigh pain and progressive leg weakness over three weeks. He had no other comorbidities and he denied any recent trauma or foreign travel. On examination he had multiple hard lumps in both thighs and blood results showed leucocytosis and raised inflammatory markers. Magnetic resonance imaging (MRI) showed multiple bilateral thigh abscesses. The diagnosis of pyomyositis was made and drains were inserted into the two largest abscesses. Simultaneously, he was started on antibiotics based on the drained fluid culture and sensitivity. On drainage of the abscesses and completion of eight weeks of antibiotics, he gradually regained the lower limbs' power and the thigh pain resolved. His recovery was aided by the better control of diabetes with insulin therapy. Pyomyositis is mainly encountered in tropical areas. Non‐tropical pyomyositis is more common in immunocompromised patients and patients with uncontrolled diabetes. It requires a high index of suspicion because of its indolent presentation that may mimic other pathologies like cellulitis, diabetic amyotrophy, septic arthritis and deep vein thrombosis. MRI is the best diagnostic tool to differentiate pyomyositis from these disorders. Early diagnosis and intervention with drainage of the abscesses and appropriate antibiotics prevent serious complications and improve the outcome. Copyright © 2017 John Wiley & Sons.

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